Landis & Landis Construction :: Application for Employment

Applicant Note

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. If employment is offered, it is strictly on an "at will" basis, which means that you may resign at any time, or Landis & Landis Construction (LANDIS) may terminate your employment at any time for no reason, or for any reason not prohibited by law. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Affirmative action hiring may be requested by qualified applicants. Additional testing of job-related skills and for the presence of drugs on your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.
General Information
Name Social Security
Address Home Phone
City, State, ZIP Code Work Phone
Emergency Contact Phone
Prior Address Have you applied at LANDIS before? Yes   No  
Prior City, State, ZIP Who referred you to LANDIS?
Availability
Position applied for: Requested Rate of Pay:
Full-Time Part-Time Temporary Date Available to Work:
Education
Level of Education Name of School From
Year		 To
Year		 Did you graduate? List Degrees
High School Yes No
College Yes No
Graduate School Yes No
Other (Specify) Yes No
Employment
Employer /
Address		 Supervisor /
Phone		 From Year /
To Year		 Position /
Salary		 Describe your job responsibilities:
Job Skills

Drivers License Number State of Issue: Is your license currently valid? Yes   No  
Type of License: Endorsements: Restrictions:
Moving violations in the last three years? Do you have other skills, licenses, or certificates that are job-related?
Have you been given a job description, or had the requirements of the job explained to you? Yes   No   Do you understand these requirements? Yes   No  
Can you perform the requirements of this job with or without reasonable accomodation Yes   No    
Security
List all counties and states of residence for the past seven years: County/State (list all):   
Have you used another name or Social Security Number, other than those listed above?
Yes   No  		If so, list all:   
Have you been convicted of a felony and/or served time for a felony within the past seven years?
Yes   No		 If so, please give details (incident, location, charge):   
References
Name Address Phone Years
Known		 Relationship
Comments
Certification, Release and ADR

I certify that I have read and understand the applicant note on this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information, including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited prior to and during employment. I agree to mediate in good faith any issue which arises concerning my hiring, my employment or termination from employment.

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